2017年美国临床肿瘤学会年会肝癌诊断与治疗研究热点和最新进展解析

Research hotspots and updates of diagnosis and treatment of hepatocellular carcinoma from 2017 annual meeting of the American Society of Clinical Oncology

2017年美国临床肿瘤学会（ASCO）年会中，肝细胞癌（HCC）诊断与治疗进展有诸多惊喜：（1）索拉非尼在进展期HCC治疗中的中心地位仍未改变，其被进一步证实可延长患者生存时间，联合其他疗法可进一步提高疗效。多种分子和临床指标有助于筛选其获益人群。（2）新型分子靶向治疗药物异军突起。多靶点酪氨酸激酶抑制剂乐伐替尼有望成为下一个一线治疗药物。二线治疗药物瑞戈非尼获得循证医学证据支持，索拉非尼与瑞戈非尼组合有望成为进展期HCC靶向治疗新模式。但c-MET靶向抑制剂Tivatinib（ARQ 197）冲击二线治疗的Ⅲ期临床研究（METIV-HCC）失败。（3）免疫疗法仍是热点。免疫检查点单克隆抗体和过继免疫疗法显示出较好的安全性和疗效。（4）HCC原发灶切除＋药物控制转移灶有望成为转移性HCC的治疗模式。行肝移植治疗原发性肝癌的地位进一步提升。（5）多种治疗手段的联合与序贯应用仍是必然而无奈的选择。立体适型放疗的疗效值得期待。TACE与其他疗法联合与序贯仍是不能行手术切除的HCC的主流治疗方式。（6）新的预后预测指标和模型层出不穷，但其效果有待进一步验证。

There were many progressions of hepatoce llular carcinoma （HCC） in the 2017 annual meeting of the American Society of Clinical Oncology （ASCO）. （1） Sorafenib has been at the heart of treatment for advanced HCC, meanwhile, it has been confirmed to effectively prolong the life time of patients and improve the clinical efficacies combined with other therapies. A variety of molecular and clinical indicators also help screening out peoples. （2） New molecular targeted drugs have sprung up, and Lenvatinib （multiple receptor tyrosine kinases inhibitor） is expected to become the next firstline drug. The secondline Regorafenib has obtained supporting evidence from evidencebased medicine, and a combination therapy of Sorafenib and Regorafenib promises to be a new model of targeted therapy for HCC. However, the phase Ⅲ study （METIVHCC） of which Tivatinib （ARQ 197） becomes the secondline drug for HCC has failed. （3） Immunization therapy remains a hotspot for HCC. The monoclonal antibodies of immunological checkpoint and adoptive immunotherapy have better safety and clinical efficacy. （4） Primary lesions resection of HCC and drug control of metastatic lesions are expected to be the therapy model for metastatic HCC. The liver transplantation for primary HCC will be further developed. （5） The combination and sequential application of multiple therapies will become an inevitable choice, and efficacy of stereotactic body radiation therapy is expected. The combination and sequential application of transcatheter arterial chemoembolization （TACE） and other therapies is still a main therapy for unresectable HCC. （6） The new predictors and models of prognosis have been popping up, nevertheless, its therapy effects should be further proven.